2002;78(5)

OBJECTIVE – Cardiac evaluation (clinical, electrocardiographic and echocardiographic) of 25 Brazilian patients with clinical diagnosis of Friedreich’s ataxia (FA) related to the frequency and the size of GAA repeats (unstable expansion of trinucleotide repeats that results in the disease). METHODS – Clinical and cardiac study including electrocardiogram and echocardiogram of all patients and molecular analysis to detect the frequency and the size of GAA expansion, by polymerase chain reaction analysis. RESULTS – Homozygous GAA expansion was detected in 17 patients (68%) — all typical cases. In 8 (32%) cases (6 atypical and 2 typical), no GAA expansion was observed, therefore it was not considered Friedreich’s ataxia. All patients with GAA expansion (100%) had electrocardiographic abnormalities, and only 25% of the cases without GAA expansion had some abnormality on this exam. However, only 6% of all patients revealed some signals/symptoms suggestive of cardiac involvement. CONCLUSION – A molecular analysis is essential to confirm the diagnosis of Friedreich’s ataxia; however, an adequate cardiac evaluation, including an electrocardiogram, was extremely useful to better screening the patients which should perform these molecular analysis.

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Correlação Clínico-Radiográfica

Caso 5/2002 – Instituto do Coração do Hospital das Clínicas da FMUSP

Edmar Atik

Correlação Clínico-Radiográfica

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Image

Bloqueios Divisionais do Ramo Esquerdo na Miocardite Reumática

Lurildo R. Saraiva et al. Inês Remígio Simone Brandão Thiago B. Saraiva

Imagem

Bloqueios Divisionais do Ramo Esquerdo na Miocardite Reumática

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Case Report

Repair of an Atherosclerotic Coronary Artery Aneurysm by Implantation of a Coronary Covered Stent

Antenor Portela et al. Raldir Bastos Itamar Costa Jayro Paiva

An atherosclerotic aneurysm of the right coronary artery complicated by a recent myocardial infarction was successfully treated with coronary artery stenting, using a device consisting of 2 stents with a layer of expandable polytetrafluorethylene (PTFE) placed between them. A follow-up angiograph 5 months after the procedure showed sustained initial results.

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Brief Reports

Glossopharyngeal Neuralgia Associated with Cardiac Syncope

Jorge Elias et al. Ricardo Kuniyoshi Wilson Valadão Hermes Carloni … Mauricio Rocha Borges Carlos Alberto Peixoto Derval Pimentel

Glossopharyngeal neuralgia is an uncommon condition that has rarely been described in association with syncope. We report here 2 cases of glossopharyngeal neuralgia in elderly patients. Both were male and underwent temporary pacemaker insertion to prevent syncopal episodes. We discuss the clinical and surgical treatment of glossopharyngeal neuralgia, the role of cardiac stimulation, and the possible physiopathological mechanism of the associated cardiac disturbances.

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Original Article

Consequences of the Prolonged Waiting Time for Patients Candidates for Heart Surgery

Nagib Haddad et al. Olímpio J. N. V. Bittar Ana A. M. Pereira Maria Barbosa da Silva … Vivian L. Amato Pedro S. Farsky Auristela I. O. Ramos Marcelo Sampaio Tarcísio L. V. Almeida Dikran Armaganijan José Eduardo M. R. Sousa

OBJECTIVE – To assess mortality and the psychological repercussions of the prolonged waiting time for candidates for heart surgery. METHODS – From July 1999 to May 2000, using a standardized questionnaire, we carried out standardized interviews and semi-structured psychological interviews with 484 patients with coronary heart disease, 121 patients with valvular heart diseases, and 100 patients with congenital heart diseases. RESULTS – The coefficients of mortality (deaths per 100 patients/year) were as follows: patients with coronary heart disease, 5.6; patients with valvular heart diseases, 12.8; and patients with congenital heart diseases, 3.1 (p<0.0001). The survival curve was lower in patients with valvular heart diseases than in patients with coronary heart disease and congenital heart diseases (p<0.001). The accumulated probability of not undergoing surgery was higher in patients with valvular heart diseases than in the other patients (p<0.001), and, among the patients with valvular heart diseases, this probability was higher in females than in males (p<0.01). Several patients experienced intense anxiety and attributed their adaptive problems in the scope of love, professional, and social lives, to not undergoing surgery. CONCLUSION – Mortality was high, and even higher among the patients with valvular heart diseases, with negative psychological and social repercussions.

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Case Report

Block of the Mitral-pulmonary Isthmus During Ablation of a Single Left-sided Accessory Pathway Causing Different Patterns of Retrograde Atrial Activation

José Tarcísio Medeiros de Vasconcelos et al. Eduardo Rodrigues Bento Costa Silas dos Santos Galvão Filho Cecília Monteiro Boya Barcellos Jaime Giovany Arnez Maldonado

The case of a 16-year-old patient with atrioventricular tachycardia caused by a single left anterolateral accessory pathway is reported. When the patient underwent radiofrequency ablation, a lesion on the mitral annulus lateral wall produced changes in the retrograde atrial activation pattern determined by that pathway; changes ranged from a delay in depolarization of the annulus posterior portions to full left atrium counterclockwise activation. Such phenomena were probably caused by a block in the isthmus between the annulus and the lower left pulmonary vein ostium. This case illustrates the importance of the mitral-pulmonary isthmus in the process of left atrium activation, an alert to changes induced by its unintentional block during accessory pathway ablation.

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Atualização

Estresse Mental e Sistema Cardiovascular

Débora Lopes Loures et al. Isis Sant'Anna Clarissa Seródio da Rocha Baldotto Eduardo Branco de Sousa Antonio Claudio Lucas da Nóbrega

Atualização

Estresse Mental e Sistema Cardiovascular

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Original Article

Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

Eduardo Cantoni Rosa et al. Valdir Ambrósio Moysés Ivan Rivera Ricardo da Cintra Sesso … Nárcia Kohlmann Maria Tereza Zanella Artur Beltrame Ribeiro Osvaldo Kohlmann Jr.

PURPOSE – To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS – Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG – normal geometry; CR – concentric remodeling; CH- concentric hypertrophy; EH – eccentric hypertrophy) and to age (60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS – A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT – 1.38±0.03 vs HT – 1.27±0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01). CONCLUSION – DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.

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ORIGINAL ARTICLE

Prevalence of Chagas' Disease in Mulungu do Morro Northeastern Brazil

Roque Aras et al. Marielza Veiga Irênio Gomes Gildo Mota … Bernardo Rodrigues Rosângela Rabelo Carmen Guzman-Bracho Ailton Melo

OBJECTIVE – The aim of this paper is to describe the prevalence of T. Cruzi infection in patients of from Mulungu do Morro, a rural tropical region of Northeastern Brazil. METHODS – A cross-sectional study was performed. After randomly selecting samples of the population, and obtaining their consents , patients completed pretested epidemiological and clinical questionnaires. Serum samples from all patients were collected and screened for the presence of T. cruzi antibodies. RESULTS – Of 694 patients examined, 174 patients (25.1%) tested had a positive serology for Chagas’ disease. Of the study population, 341 patients were male with 27% Chagas’ disease prevalence, without a statistical difference. Illiteracy was the only variable related to T. cruzi infection in our population. CONCLUSION – In conclusion, our study points to the high prevalence of Chagas’ disease among patients in Mulungu do Morro, suggesting that this region has a high frequency of infection and probably active vectorial transmission.

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ORIGINAL ARTICLE

Prevalence of Risk Factors for Coronary Artery Disease in the Brazilian State of Rio Grande do Sul

Iseu Gus et al. Airton Fischmann Cláudio Medina

OBJECTIVE – To determine the risk factors prevalence for coronary artery disease in the State of Rio Grande do Sul, Brazil and to identify their relation with the age bracket. METHODS – We carried out an observational, cross-sectional study of 1,066 adults older than 20 years in the Brazilian State of Rio Grande do Sul. We investigated the risk factors: familial antecedents, systemic arterial hypertension, high levels of cholesterol and glycemia, overweight/obesity, smoking and sedentary lifestyle. A standardized questionnaire completed at the patients’ dwellings by health agents were used; the data were stored in an EPI-INFO software database. The results were expressed with a 95% confidence interval. RESULTS – The sample composition was of 51.8% females. The risk factors prevalences were: 1) sedentary lifestyle 71.3%; 2) familial antecedents: 57.3%; 3) overweight/obesity (body mass index >25): 54.7%; 4) smokers: 33.9%; 5) hypertension: 31.6% (considering >140/90mmHg) and 14.4% (considering >160/95mmHg); 6) high glycemia (>126 mg/dL): 7%; 7) high cholesterol >240 mg/dL): 5.6%. CONCLUSION – The prevalence of the major risk factors for coronary artery disease in the Brazilian state of Rio Grande do Sul could be determined in a study that integrated public and private institutions.

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